Inflammation as a predictor for depression in multiple sclerosis

抑郁症是多发性硬化症(MS)最相关的并发症之一，因其对患者生活质量的影响以及对各自经济负担的贡献。识别抑郁的预测因素将有助于尽早启动诊断和治疗步骤，并改善多发性硬化症的护理。对严重抑郁障碍(MDD)的研究强调了炎症分子与抑郁症状发展的相关性。因此，从科学和临床的角度研究炎症过程及其与多发性硬化症抑郁症状的相关性--多发性硬化症本身就是一种慢性炎症状态--是非常有趣的。我们的项目解决了一个悬而未决的问题，即哪些炎症标志物可以预测新诊断的MS患者抑郁症状的发展。我们专注于研究在MS和MDD患者中都可以检测到的血清标志物。此外，它们可以很容易地通过微创程序获得，因此有可能在以后的临床常规中实施。此外，我们还考虑了其他临床、人口统计学、实验室和影像参数(特别是多发性硬化症病变和病变部位)作为抑郁症的预测因子。该项目被设计为一项前瞻性队列研究，包括两个队列(60名新诊断的MS患者和60名MDD患者，在过去12个月中没有抗抑郁药物服药史)，并在基线和12个月后的随访中进行测量。血清炎症标志物(C-反应蛋白、白蛋白、IL-1、sIL-2R、IL-3、IL-6、IL-12、IL-17、IL-18、IL-38、肿瘤坏死因子-α、Th1/Th17/T-调节性淋巴细胞)以及临床(包括作为身体残疾指标的EDSS)和其他变量(对于MS患者：基线时的脑脊液和基线及随访时的磁共振参数)将被检测为抑郁症状的预测因子。此外，MS和MDD患者之间的比较将有助于识别与抑郁症状的发生相关的炎症标志物，特别是在MS患者中。疾病调整治疗对抑郁症状和促炎分子的影响也将被研究。这项研究的洞察力将使我们能够确定MS患者出现抑郁症状的风险更高。可以对这些患者进行更密切的监测，并在必要时及时提供相应的治疗。因此，MS相关性抑郁症的疾病负担可以显著减轻。

Due to its effect on patients’ quality of life and its contribution to the respective economic burden, depression is one of the most relevant comorbidities of multiple sclerosis (MS). Identifying predictors of depression would allow initiating diagnostic and therapeutic steps as early as possible and improve MS care. Major depressive disorder (MDD) studies have highlighted the relevance of inflammatory molecules in the development of depressive symptoms. Thus, investigating inflammatory processes and their relevance for depressive symptoms in MS – which itself is a chronic inflammatory condition – is highly interesting from both scientific and clinical point of view. Our project addresses the unanswered question which inflammatory markers predict the development of depressive symptoms in newly diagnosed MS patients. We focus on studying serum markers which can be determined in both MS and MDD patients. Furthermore, they can be easily obtained with a minimally invasive procedure and are thus potential candidates for a possible implementation in the clinical routine at a later stage. Additionally, we consider also other clinical, demographic, laboratory and imaging parameters (especially MS lesions and the lesion location) as predictors of depression. The project is designed as a prospective cohort study with two cohorts (60 newly diagnosed MS patients and 60 patients with MDD and no history of antidepressant medication in the last 12 months) and measurements at baseline and at a follow-up 12 months later. Serum inflammatory markers (CRP, Albumin, IL-1, sIL2R, IL-3, IL-6, IL-12, IL-17, IL-18, IL-38, TNF-α, Th1-/Th17-/T-regulatory lymphocytes) as well as clinical (including EDSS as an indicator for physical disability) and other variables (for MS patients: cerebrospinal fluid at baseline and MRI parameters at baseline and follow up) will be tested as predictors for depressive symptoms. Furthermore, a comparison between MS and MDD patients will allow the identification of those inflammatory markers, which are relevant for the occurrence of depressive symptoms especially in MS. The effects of disease modifying therapy on depressive symptoms and proinflammatory molecules will be studied as well. The insights from this study would allow to identify MS patients with a higher risk for developing depressive symptoms. Those patients could be more closely monitored and a respective treatment could be provided timely, if necessary. Thus, the disease burden of MS-related depression can be significantly reduced.